Influenza Control Program Frequently Asked Questions Wearing a Mask Influenza or the flu can be a serious contagious disease, which is spread by droplet transmission through close contact with an infected person. Infected individuals are highly contagious and can transmit the virus for 24 hours before they show any symptoms. Each year, across Canada there are between 2,000 and 8,000 deaths from influenza and its complications. Influenza causes by far the most deaths among vaccine-preventable diseases, outpacing all others combined. Hospitalized patients and seniors in residential care are more vulnerable to influenza than healthy adults. The vaccine is also less effective for frail seniors or other hospitalized patients, making it even more important that their caregivers are vaccinated. Infected health care providers can pass the virus on to their patients before they even know they are sick. The most effective way to prevent the flu is by getting vaccinated, when combined with other preventative measures, such as proper hand hygiene. Immunization helps physicians, health care providers and those who come into regular contact with patients reduce their risk of contracting influenza, and spreading it to their patients. To protect patients in our facilities, in 2012 British Columbia s health authorities adopted a policy requiring all employees, students, physicians, residents, contractors, vendors and volunteers to get immunized or to wear a mask during influenza season when in a patient care area. To further protect patients, the policy was expanded to include all visitors to our health care facilities. What is a Patient Care Area? A patient care area/location is defined as an area within a health care facility, including a contracted facility, that is accessible to patients, residents or clients who are there to access care or services including, for example, hallways or lobbies. It includes any other location where care is provided, such as home and community care locations (including a client s home). It does not include
locations such as administrative areas or private offices which are not generally accessed by patients, residents or clients. What is the masking portion of this policy? The most effective way to prevent the flu is by getting vaccinated, when done in combination with other preventative measures, such as proper hand hygiene. This policy requires that all employees, physicians, residents, students, volunteers, vendors and contractors be vaccinated against the flu each year or, for those unable or unwilling to get immunized, to wear a procedure mask when in patient care areas during the designated required vaccination period, typically from the beginning of December to the end of March. Visitors are also included in this policy, and so will be expected to wear a mask when in health care facilities, if unvaccinated. Why do unvaccinated workers need to wear a mask? While vaccination offers the best protection, masks can help to prevent transmission of the virus from an infected health care provider, who may have no or minimal influenza like symptoms. Masks may also protect unvaccinated health care workers from infected patients or visitors with influenza. In conjunction with proper hand hygiene, masks have been shown to reduce rates of influenza-like illness in residents of college dormitories and households. Masks can filter influenza virus particles to undetectable levels when measured at a distance of 20 cm from an infected patient. What type of mask should I wear? Procedure masks are used in this policy. These have been shown to be effective at reducing transmission from an infected person in several studies, and have been shown in a randomized controlled study to be as effective at preventing transmission of influenza as N 95 respirators in an acute care setting.
Where do I need to wear a mask and how long should I wear it? While the most effective way to prevent the transmission of influenza is to get a flu shot, and follow other preventative measures such as proper hand hygiene, if you are not vaccinated you must wear a procedure mask whenever you are in a patient care area during the required vaccination period. You do not need to wear a mask when eating or drinking. Unvaccinated workers are also not required to wear a mask in administration only areas, including a private office, which are not generally accessed by patients, residents or clients. When do I need to change my mask? Simply change your mask when it gets overly moist there is no set time designated when you need to change your mask. It is important that you dispose of your used masks appropriately. Please dispose of masks in an available garbage can, and follow proper hand hygiene protocols before replacing with a new mask. Please note, for this policy, we require that you wear a mask to prevent the transmission of influenza from you to a patient. This is different from when you might wear a mask to protect yourself from infection in a health care setting. Routine infection control and safety practices unrelated to this policy (such as the use of respiratory protection, eye protection and hand hygiene) should not be affected by this policy. The use of masks for routine practices and additional precautions should continue as part of effective infection prevention and control programs. For example, if you need to wear a mask as part of your personal protective equipment for providing care to a patient with a droplet transmitted infection, you should follow the appropriate procedures (including hand hygiene, use of eye protection, gowns, etc.), including putting on a new mask prior to patient contact and taking off the mask after patient contact. If airborne precautions are required (for example when caring for a patient with tuberculosis), then the mask should be substituted for an N 95 respirator and usual infection control practices for airborne precautions followed.
What is the mask policy during an outbreak? Wearing a mask, in conjunction with hand and respiratory hygiene, reduces the risk of influenza transmission; however, this remains secondary in effectiveness to influenza vaccination. During an outbreak, additional measures are needed to prevent further transmission of illness in the facility because of the higher risk that exists at that time. That is why, during a facility influenza outbreak this policy will be suspended at the outbreak location and the facility s existing outbreak policies regarding the use of exclusion and antiviral medications will apply. What do I do if a colleague tells me they have not been immunized and I see them working without a mask? This policy is in place to help protect our vulnerable patients, so we ask that you support and encourage one another in following it. Please remind your coworkers of their responsibility to their patients and ask them to wear their mask so they don t transmit infection. Encourage each other with all aspects of the policy, including hand hygiene, respiratory etiquette and staying home when sick. If they continue to ignore the policy, you are asked to report this behaviour to your supervisor, in the same way you would with any other patient safety concern. What arrangements are in place to ensure mask wearing does not interfere with patient care? There are many instances within healthcare settings outside of this policy where staff must wear masks. Research during the SARS outbreak, when masks were widely used, showed that patients fears could be allayed by simply explaining the reasons for mask wearing. This included pediatric studies where parents supported the use of masks to reduce the risk of disease transmission. In all health care settings including mental health, speech pathology and seniors or pediatric care we encounter patients who are vulnerable to infection.
It is important that we do everything we can to protect them from the risk of contracting influenza. While wearing a mask may seem inconvenient, that inconvenience is outweighed by the importance of protecting our patients. To help explain the policy to patients or clients, health care facilities will have posters outlining that the policy is in effect, and that masks are being worn to protect them from infection. In addition, health care providers should explain why they are wearing a mask. What arrangements are in place to accommodate staff with allergies or contra-indications to the use of masks? Unvaccinated staff member with medical contra-indications wearing a mask will be individually assessed by a Medical Health Officer or Workplace Health respectively, in accordance with established duty to accommodate processes and the Human Rights Code We know that you are committed to protecting your patients, and thank you for your dedication to their safe care and well-being.